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HomeMy WebLinkAboutTHE TABLELANDS BLK 5 LT 9The Tablelands
Block 5
Lot 9
#051-801-23
Municipality of Anchorage Page 1 or 3
Development Services Department
Onsite Water and Wastewater Program
1700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.d.anchorage.ek.us (907) 3117904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. SWO40357
PID Number. 051.801.23
"�"nell Homes
S i
Wastewater System: New
Fes...
1900 W. Northern LI hts Ste. 200 Anch., AK 99517
ABSORPTION FIELD
344 5678
F ve 5
5' Wide Trench
LEGAL DESCRIPTION
so+a.rp
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,45 GPD,Fe
7 Ft.
Block Lot sutmmrm.
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5 9
Tablelands
3 Fr.
4 FL
TOW W W n.Vk
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168 Ft
Well: Awwu water System
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5
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Ft
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YWa.
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TANK
PM
Ct.
F
Ft
SEPARATION DISTANCES
® Septic ❑ Holding ❑ S.T.E.P. ❑ Other.
To
From
Septic
Tank
Absorption
Field
Litt
Station
Holding
Tank
ohrmnva(e
sawaru a
Anchorage Tank
1,500
WON
>200'
>200'
WA
WA
>25
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>100'
>100'
WA
WA
LIFT STATION — NONE ON LOT
to L"
>5'
>10,
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>10,
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WA
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in
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Noted
PMW M" a Moir
rano hepryprn p.rka q
R�
BENCH MARK
an as
Finished Floor.
100.0 Ft
Engineer's Stamp
P
Inspections performed by: T. Kimbrouah
Dates: 1" 9/17/04
; 49th
•
2 9121/04`h
Department
and Human Services approval
MICHAEL E •NDCR50N W �
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Reviewed and approved by
Date:.
♦ No EE -4381
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Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number. SW040357
TBM
Page 3 of 3
PID No. 051-801-23
d XS U in
U S
4
PROFILE AS -BUILT
Scale: 1' - 20•
.MICHAEL E. ANDERSON
�A. No. CE -UNI
•.•_ unvo4 _..'c
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 SOUTH BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: LOT 9, BLOCK 5, TABLELANDS S/D 0j./'••. No. C[r7
PERFORMED FOR: SPINFI_I HOMFS
DATE:9/21/2004 PROJECT No -M0442 ��::
PARCEL ID,.- TECHNICIAN: T.L. KIMBROUGH Professional En
DEPTH TEST HOLE #3 Type of Test: ❑ Percolation ❑ Visual
(fw)
1
2
3
4
5
6
7
8
9
I
1
1
1
1
1
1
OB/OG
SILTY SANDY GRAVEL
MEDIUM COMPACTION
GM
SLOPE
0%
SITE PLAN
SEE SITE PLAN Y
C
Y
WAS GROUND WATER ENCOUNTERED? No
IF YES @ WHAT DEPTI1? 0%
DEPTH OF WATER AFTER MONITORING:
DATE OF MONITORING:
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH OF
WATER
(INCHES)
NET DROP
(INCHES)
TEST HOLE PRESOAKED PRIOR TO TESTING:
6/23
1
10:05
9.38"
2
10:35
30
8.511
.881,
3
11:05
30
7.7511
.75"
4
11:35
30
711
.75"
5
12:05
30
6.2511
.75"
PERCOLATION RATEL�O (MINANCFI) FERC. HOLE DIA, INCHES)
TEST RUN BETWEEN: 4 Fr, and -5 FT.
COMMENTS: SAME SOIL MATERIALS AS FOUND IN TEST HOLES I AND 2.
NO IMPERMEABLE LAYERS ENCOUNTERED. TEST HOLE PRESOAKED PRIOR TO TESTING.
TEST PERFORMED BY VETECII ENGINEERING TECHNICAL SERVICE. 1, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE: 2/23/2005
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 FAX
MEMORANDUM
DATE: March 7, 2005
TO: Julie Makela, P.E.
FROM: Mike Anderson, P.E.
SUBJECT: Lot 9, Block 5, Tablelands Subdivision
Septic System Inspection Report
As -Built Survey
The profile view of the Septic System Inspection Report has been amended to indicate
the correct elevations for the trench bottom of the absorption trench. A minimum of 4'
of drainfield rock was placed under the distribution line. The crew working on the
project were inexperienced and were not exact in the placement of the monitor tubes.
The post tank cleanouts were moved to within 10' of the septic tank after the surveyor's
as -built was completed. We have modified the as -built to show the current placement
of the post tank cleanouts.
Municipality of Anchorage
Development Services Department
• +� Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET
To: Anderson Engineering
Legal description: The Tablelands, Block 5. Lot 9
The attached paperwork has been reviewed and Is being returned for the following reasons:
❑ Original signature or stamp missing on
❑ Calculation error in design. _
❑ Additional soils information needed. _
❑ Water monitoring results inadequate. _
❑ Discrepancy in information submitted.
❑ Topographic information missing or inadequate. _
❑ Incomplete; missing
❑ Incomplete; missing _
❑ Additional adequacy test information needed.
❑ Water sample unacceptable. _
❑ Measured/proposed distances/dimensions missing.
❑ Locations of all soils, percolation and water monitoring tests not shown. _
❑ Proposed system too deep for soils Information submitted. _
❑ _ Well log required.
❑ Omission in narrative.
❑ Insufficient fill over tank or field._
® Other. 1.) Please verify depth of sewer rock beneath absorption fiel<
surveyors as -built and Inspection Report site plan).
Name of reviewer. Julie Makela. P. E.
Date: 3/4/2005
Please supply the necessary information and re -submit your request.
LEAVE THIS FORM ATTACHED TO THE PAPERWORK
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water 8 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
yt7:00
'7I9,i 170
Date Issued: Aug 24, 2004
Expiration Date: Aug 24, 2005
Permit Number: SW040357 Parcel ID: 051-801-23
Legal Description: THE TABLELANDS SUBDIVISION BLOCK 5 LOT 9
Design Engineer: 0014 Anderson Engineering Site Address: NHN WHISPERING BIRCH DRIVE
Owner Name: SPINELL HOMES, INC. Lot Size: 40003 SQ. FT.
Owner Address: NHN WHISPERING BIRCH DRIVE Total Bedrooms: 5 Permit Bedrooms: 5
EAGLE RIVER. AK 99577 -
This permit Is for the construction of.
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
Maximum depth of aborption trenches shall not exceed 7 feet below original grade.
Received
Date:
Municipality of Anchorage
• Development Services Department
Building Safety Division
i On -Site Water and Wastewater Program
4700 South Bragaw St
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. OSI - 801-a3 Permit Number SW
Property owner(s) Sgineit Homes, Inc. Day phone 3445678
�M,aaiiling address (1)1900 W. Northern Lights Boulevard, Suite 200 Anchorage, AK 99517
IA 4mg address (2) NM \kPl3PF.RINI '?ArLb Dr. M Zip Code _ Qi5-4-4-
Legal description (Lot, Block & Sub'd.) lot 9. Block 5. Tablelands Subdivision
Legal description (Section, Township & Range)
Lot Size 40.003 SF Acre
THIS APPLICATION IS FOR:
Number of Bedrooms Five (5)
Sewer Only ® Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees: ` '100 -
Date
l00Date of Payment 131 1 q W
Waiver Fees:
Date of Payment
Receipt Number. Receipt Number.
(Rev, 12/00)
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 FAX
August 18, 2004
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 9, Block 5, Tablelands Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 9, Block 5, Tablelands Subdivision intends to construct a new five -
bedroom home on the lot. We are therefore requesting a permit be issued for the
construction of a new septic system to serve the new home. The subdivision is served
by a community water system and no conflicts exist with adjacent septic systems or
wells. The attached Site Plan and backup documentation identify the location and
configuration of the proposed septic system and alternate site. The water service line is
also shown. The current drainage pattern along with spot elevations is identified on the
Site Plan. The drainage pattern will be maintained after development of this lot is
complete.
A test hole recently placed on the lot indicated silty sand and gravel in the area of the
absorption trench. The accepting soils were tested and found to have a percolation
rate of 40 minutes per inch. No groundwater was found in the test holes during
placement and none was noted during the monitoring period. Our design includes the
placement of a new 1,500 -gallon septic tank along with 2 - 84' long by 5' wide by 4'
effective depth absorption trenches to collect and treat the sewage generated in the
house. The bottom of the trenches will be 7' below the surface. The distribution pipe
will be 3' below the surface. A minimum of 3' of cover will be placed atop the trenches
and a minimum of 4' of cover will be placed atop the new septic tank.
The ground surface on the lot slopes at shallow grades from south to north as shown
on the Site Plan. The absorption trenches will be constructed parallel with the slope of
the ground surface as much as possible in conformance with Municipal requirements.
The new septic system will be constructed a minimum of 10' from the water service
Lot 9, Block 5, Tablelands
August 18, 2004
Page Two
proposed for the lot and on adjacent lots. It will also be constructed a minimum of 100'
from any surface water in the area.
If the system is constructed in accordance with our design the following statements
apply:
The system, if constructed as designed, will have no adverse impact on the wells
in the area or those to be constructed in the future.
2. The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
3. The system, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
4. The system, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
.S�,i�n�ce�r�/e�ly,� F
Michael E. Anderson, P.E.
Attachments
_O
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0
N cy� O
W
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F-
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H
LOT 9, BLOCK 5, TABLELANDS SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Five Bedroom House 5' Wide Trench System
Pero Rate: 30-60 Min./inch 1,500 Gallon Septic Tank
Application Rate: A5 GPD/SF 4' Drainfield Rock
5 Bedrooms X 150 GPD/.45 GPD/SF (Application Rate) = 1,666.7 SF Absorption Area
1,666.7 SF/5 SF • .5 (Red. Factor) = 166.7 LF Trench Length
THEREFORE: Construct 2 - 84' Long x 5' Wide x 4' Effective Depth Absorption Trenches.
Flow Line Elevation in Trenches to be 3' Below Original Ground Surface. Total Depth to be
7' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over
Absorption Trench. Provide 2" of Insulation and 2' of Cover if Necessary. Placea
Flow Splitter Valve to Insure Even Flow to Each Trench.
2'6"
6"
4'0"
TYPICAL 5' WIDE 7
NOTE:
Natural
Backfill
5'
SCALE)
Geotextile
Fabric
Perforated
rC (Holes Down)
Drainfield Rock
Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock.
Minimum 4' Separation From Groundwater.
Minimum 10' Separation From Water Services in the Area.
Minimum 100' Separation From Surface Water or Streams.
DEPTT
Ir,�n
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 SOUTH BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: LOT 9. BLOCK 5. TABLELANDS S/D
PERFORMED FOR: SPINFI I
DATE: 8/3/2004 PROJECT No•M0464
PARCEL IDN- TECHNICIAN: T. L. KIMBROUGH
1 TEST HOLE # 1
SILTY ORGANICS/OB SLOPE
SILTY—SANDY—GRAVELS
GM
m
IT PAN
TH2
0
'!H1
0
CURE KEY
SFF FUTURF ASRUII T
WAS GROUND WATER ENCOUNTERED? NO
IF YES 0 RTIAT DEFTIV 0%
DEPIN OF WATER AFTER MONITORING: NONE
DATE OF MONITORING: R�ISro(.
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH R F
(INCHES)
INET DROP
(INCHES)
8/3/04
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
11:00
11.5"
CHARGE
2
11:30
30
10.75'
0.75"
3
11:30
12.0"
RECHARGE
4
12:00
30
11.25"
0.75"
5
12:00
12.0"
RECHARGE
6
12:30
30
11.25"
0.75"
PERCOLATION RATE`(MIN/INCII) PERC. HOLE DIA,�INCIIES)
.5
TEST RUN BETWEEN 4FT. and 5.5 FT.
COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY VETECH ENGINEERING TECHNICAL SERVICE. 1, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE-
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 SOUTH BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: LOT 9. BLOCK 5. TABLELANDS SID
PERFORMED FOR: SPINFI I
DATE: 8/3/2004 PROJECT No -M0464
PARCEL ID,#- TECHNICIAN: T. L. KIMBROUGH
DEPTII TEST HOLE # 2
Ox1)
1 SILTY ORGANICS/08
SLOPE
0%
O:lIQ VWAS l GROUND WATER ENoouNTrRmr n
rDEPTH OF TERR AFTER MONITORING:
le
14
15
16
17
18
19
0
NEL L ANDERSQI
No. CE -4381 i
SITE PAN
TH2
0
THA
0
CURB KEY 1
a'
SFF FUTURE ASRUILT
�0
DATE
READING
G OSS TIME
MINUTES)
NET TIME
(MINUTES)
DEPTH OF
WATER
(INCHES)
NET DROP
(INCHES)
8/3/04
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
11:05
12.0"
CHARGE
2
11:35
30
10.875"
1.125"
3
11:35
12.0"
RECHARGE
4
12:05
30
11.25"
0.75"
5
12:05
12.0"
RECHARGE
6
1 12:35
30
1 11.251@10.75"
PERCOLATION RATE;-4-0(MW/INCFq PERC. IIOLE DIA, � (INCIIES)
TEST RUN BETWEEN 4.5 FT. and 5.5 FT.
COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY VETECII ENGINEERING TECHNICAL SERVICE. 1, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE.
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 9, BLOCK 5, TABLELANDS SUBDIVISION
GENERAL:
1. The scope of this project includes the procurement and placement of a new
1,500 -gallon septic tank at the location shown on the Site Plan. Work also
includes the construction of 2 new 84' long X 5' wide X 4' effective depth
absorption trenches at the location also shown on the Site Plan. The
distribution line in the trench will be placed at 3' below the existing ground
surface. Total depth of the trenches will be 7' below the existing ground
surface. A flow splitter valve must be placed to insure even flow to each
trench. A separation distance of 10' from any water service and 100'
between the septic tank and absorption trenches and any surface water must
also be maintained. A minimum of 3' of fill is required over the absorption
trenches and 4' over the septic tank. In lieu of the required fill 2" of insulation
and 2' of fill may be placed.
2. Construction shall be in accordance with the approved site plan, design
drawings, Municipal Permit with any special provisions or conditions, and all
applicable State and Municipal Wastewater Disposal Regulations.
3. The Contractor shall be responsible for obtaining all underground utility
locates and for the layout of the septic system and verification of the location
of all lot lines. The Contractor must also verify the location of wells in the
area and assure that the separation distances are met.
4. Unless specifically agreed otherwise, the contractor shall be responsible for
final grading areas subsequently depressed from soil settling. Property
owner shall be responsible for revegetation of affected areas unless
specifically agreed otherwise.
5. Contractors installing wastewater disposal systems must be certified by the
Municipal Department of Health and Human Services for system installations.
Owners installing their own systems must receive prior approval from
D.H.H.S. before beginning system installation.
SEPTIC TANK INSTALLATION
1. A new 1,500 -gallon septic tank must be procured from an approved source
and installed at the location shown.
2. A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
Lot 9, Block 5, Tablelands
August18,2004
Page 2 of 3
3. The septic tank shall be sufficiently bedded to prevent settling or shifting of
the tank.
4. All standpipes on the septic tank shall extend a minimum of 12 inches above
final grade.
5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial
insulation.
6. A foundation cleanout shall be installed one to four feet from the building
foundation. Two cleanouts are required between the tank and the drainfield.
7. Final grading over the tank shall be such that a positive slope exists away
from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown on the design.
The bottom of the trench shall be within 2" of level.
2. Distribution piping must be placed level with perforations down atop a level
bed of drainfield rock. Rock should then be placed over the pipe to provide a
minimum of 2" of cover.
3. A silt barrier or geotextile fabric must be placed between the drainfield rock
and the natural soil backfill.
4. Monitor tubes must be 4" in diameter and installed at the locations shown on
the design. The portion below ground must be perforated.
5. Contractor shall verify the septic tank and drainfield are a minimum 100' away
from any private water wells in the area, 150' from a Class "C" Well or 200'
from any community well.
6. Direct bury insulation must be placed over the distribution system if less than
3' of backfill depth is available. Finish grade over the trench must be
mounded to prevent settlement or depressions.
7. Grade area surrounding the absorption trench to drain away.
8. A minimum 2' of accepting soil is required below the drainfield rock for a 5'
wide trench. Contractor shall verify this condition prior to placement of the
rock. All pockets of unacceptable materials must be removed and replaced.
Lot 9, Block 5, Tablelands
August 18, 2004
Page 3 of 3
MATERIAL SPECIFICATIONS:
Septic tanks must be constructed by a Municipally approved septic tank
manufacturer.
2. The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and
solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662
or A.B.S. (perforated and solid).
3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow
Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Femco, or equal).
5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed
between the final drain rock layer and the native soil layer.
6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the
#200 sieve.
INSPECTIONS:
Municipal Ordinance requires a minimum of two inspections. These inspections
must be conducted under the supervision of a professional engineer registered
in the State of Alaska. The first inspection must be conducted after the
excavation of trenches, beds or pits and before the installation of any gravel. A
septic tank may be set in place, but may not be backfilled.
The second inspection must be conducted after the placement of the geotextile
fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No
backfill should be in place at the time of inspection.
Contractor shall provide a copy of all field survey layout and construction notes
for use in preparing the certified as -built of the completed system.
Parcel I.D.
0
Municipality of Anchorage
On -Site Water and Wastewater Program
_ _7y 343-79044
`� tJ
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
X51 -93
1. GENERAL INFORMATION
Complete legal description
expiration nate: _ �0 -/ O - 1
The Tablelands S/D, Block 5, Lot 9
Location (site address) 22855 Whispering Birch Drive, Chugiak, Alaska
Current Property owner(s) HOavard Hunt Day phone 632-80921r, 6692_3KfaMV
Mailing address
Real Estate Agent
Audrey Mason, ReMax of Eagle River
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
622-3344
3. NUMBER OF BEDROOMS:
5
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual
n
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
Ej
Public Sewer
❑
Received by: Date: �Z
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $. I40l0 Waiver Fee $
Date of Payment 1 C3� z CJI \A r, Date of Payment
Receipt Number O ��j ��j� Receipt Number
COSA # 0bC i a t A�(.c Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
Shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Douglas T. Kenley, P.E. Phone (907) 74&-1073
Address 9806 E. Northstar Circle, Palmer, AK 99645
Engineer s Prilrted Name Douglas T. Kenley C ---
S. ©SD SIGNATURE
System #1 Approved for, bedrooms.
System #2 Approved for. bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following
By: Zt/, Original Certificate Date: /V - 25- '/Z
Theunicip ity age Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 6 by an independent professional cW engineer registered in the. State of Alaska.. Tisa Municipatrty
of Anchorage is not responsible for errors or omissions In the professional engineers work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory_ Arsenic Advisory
Well Flow Advisory Other
COSA btue sheet A1-12.tl c
If more than 1 septic system is on the lot:
COSA Checklist # of _
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: The Tablelands S/D, Block 5, tot 9 Parcel ID: 051-801-23
A. WELL DATA
WellPublic
type _ If A, B, or C provide PWSID # _ Well Log (Y/N)
Date completed T Sanitary seal (YIN)
Total depth ft. Cased to ft.
FROM WELL LOG
Date of test
Static water level
hJ
Well production g,p,m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate mg/L
Arsenic: _ ug/L date of sample:
B. SEPTICIHOLDING TANK DATA
Tank Type/Material Septic/Steel
Tank size 1500 gal. Number of Compartments 2
Wires properly protected (Y/N)
Casing height (above ground) in.
AT INSPECTION
ft.
9 -
P.m -
Other bacteria colonies/100 mL
Collected by:
Date installed 9/17-21/04
Clesnouts (Y/N) Y
Foundation cfeanout (Y/N) Y Depression over tank (YIN) N High water alarm (YIN) N/A
Date of pumping 9/27/12 Pumper Sanitary Pumpers
C. ABSORPTION FIELD DATA
Date installed 9/21/04 Soil rating (g.p.d./ftz orftZlbdrm) 0.45 System type 5' Wide
Length 168 ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth7=9 ft. Eff, absorption area 1680 ftz Monitoring tube Y Depression over field N
Date of adequacy test 10/10/12 Results (Pass/Fail) PASS For 5 bedrooms
Fluid depth in absorption field before test 36 in. Water added 935 gal New depth�'s in.
Elapsed Time: 1243 min. Final fluid depth 36 in. Absorption rate >= 750 g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date --
D. uFTSTATM
0 -ate installed
"Pump
Datum
Size in gallons
in. "Pump off" level at _ in.
Cycles tested
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/liftstabi on lot
Manhole/Access (Y/N)
High water alarm level at
Meats alerrwit requirements?
equirements?
On adjacent lots
A tion field on lot
On adjacent lots _
- '
Public sewer main
Public sewer manhole/cleanout
Sewer ]septic service line
Holding tank
Animal containment areas
Manurefanimail e=ete storage
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ ft. Property line 10+ IL
Water main 10+ ft. Water service line 10+ ft.
Wells on adjacent lots 100+ ft.
ABSORPTION FIELD ON LOT TO:
Property line 10+ ft. Building foundation 10+ ft.
Water Service line 10+ ft. Surface water 100+ ft.
Curtain drain None Known Welts on adjacent lots 200+ ft,
Absorption flet
Surface water
in.
d 5+ ft.
100+ ft.
Water main 10+ ft.
Driveway, parking/vehicle storage 5+ ft.
F. COMMENTS
There are two trenches. The bottom trench had 48" at the beginning of the test. Water was introduced into the top trench
which had two monitoring tubes, but only one is shown. Its readings were 31", 34-5/8", and the final reading was 32-3/4".
G. ENGINEER'S CERTIFICATION
1 certify that i have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA gufdeif res in effect on Um date.
Engineer's Printed Name Douglas T. Kenley
Date I fl�LZ�f v
CDSAbrnvm s1ems 9-1-1244
eeanso� TIDO
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UNDER NO CIRCUMSTANCES SHOULD AN AS-BUILT BE USED FOR CONSTRUCTION OR FOR ESTABUS14WO BOUNDARY OR FENCE IDES
THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY,
LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE.
WT AIRt£[ SURVEY TYPE
SYMBOLS
FaLYgATwN AS-ears
El FINN. SmemE A4-BllrT
T REBAR 7 W DRAINAGE 0 ASPHALT
❑ PIDT PINI ... Ae-&ULT ... LM sMLEY _ .. RPOQIAPHY
-FENCE..® CONCRETE
ET
A9-&Ri ... W Mftn SET Rf TIRi AS-BULT ... WNt{R9 gT
® ASSUMED ELEV. -1( It 11- MM,LL FENCE WOW DECK
PLOT PLANS & LOT SURVEYS
NOTE:
IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO
CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE
ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE
SHOWN. FENCES, YELLS, SEPTIC CLEANOUTS. SIDEWALKS ORIVEWAYS,
TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE
ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW
THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT.
MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED.
ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED.
SURVEY CERTIFICATION'.�tt��r
'
Prepared by
PLOT PLAN
Robert E. Johns, Jr. & Assoc.
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Professional Land Surveyors
Brews
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1700 Brink Orkm
ANCHORAGE, ALASKA 99504
III
Scale: 1„ _ 56,
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Rec Lot S.F.
Rec. Plot File No.
FOUNDATION AS-BUILT
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Legal Description:
� '"
♦♦ eoP a...............ara :•
Lot 9 BLOCK 5
eas
THE TABLELANDS
Municipality of Anchorage
+` Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
Septic System Advisory
Certificate of On -Site Systems Approval # 121486
During a recent adequacy test on the septic system for Block 5, Lot 9 of The
Tablelands subdivision, 36 inches of standing water was observed in the
absorption field. This indicates that approximately 88% of the absorption
area is inundated. Although this system passed the adequacy test, the
remaining life expectancy may be limited.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval
Municipality of Anchorage
• --' Development Services �Department , Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. D51-wi-93 COSA#_ MY14
Expiration Date: / O -- � S? — O
1. GENERAL INFORMATION
Complete legal description
The Tablelands SID, Block 5, Lot 9
Location (site address) 22855 Whispering Ruch Drive, Chugiak, Alaska
Current Property owner(s) FHLMC
Mailing address SCCA (�LANi) PR' 1111
Lending agency Countrywide Home Loans
Day phone
Day phone (907) 357-5990
Mailing address 1981 East Palmer-Wasilla Highway, Suite 200, Wasilla, Alaska 9%54
Real Estate Agent
Cad Brent, Century 21
Day phone
(907) 352.5100
Mailing Address
991 North Herman Road, Suite 100, Wasilla, Alaska
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
5
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site❑
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑�
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm
Address
Douglas T. Kenley, P.E. Phone (907) 746.1073
9606 E. Northstar Grde, Palmer, Alaska 99645
Engineer's Printed Name Douglas T. Kenley
5. DSD SIGNATURE
t,"" Approved for bedrooms.
Date 0�
OF A
4s� µ
Disapproved. :f_r
Conditional approval for bedrooms, with the following stipulations:
.r• .,)
T KDW
Attachments:
COSA Checklist X Arsenic Advisory
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Original Certificate Dater
(Rav /veal
r..
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water 8 Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: The Tablelands SID, Block 5. Lot a Parcel ID: 051.601-23
A. WELL DATA
Well type 22bN If A. B, or C provide PWSID # — Well Log (YIN)
Date completed — Sanitary seal (YIN) _ Wires properly protected (YIN
Total depth ft. Cased to ft. Casing height (a ground) in.
FROM WELL LOG ATI CTION
Date of test
Static water level
Well production
WATER SAMPLE
Coliform
9 P.M.
mL Nitrate mg/L
9.p -m.
Other bacteria colonies/100 mL
Arsenic: mgA Date of sample: _ Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 9/17-21/2004
Tank size 1500 gal. Number of Compartments 2 Cleanouts (YIN) Y
Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (YIN) NIA
Date of pumping 10222006 Pumper Sanitary Pumpom
C: ABSORPTION FIELD DATA
Date installed 0212004 Soil rating (g.p.d.Rt2 or ft2lbdrm)±5 GPD/SF System type T wide shallow trench
Length ' 64+64=166 ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth 6 ft. Eff. absorption area 1660 fe Monitoring tube Y Depression over field N
Date of adequacy test 1O21 8 t0r3M Results (Pass/Fail) Pass For 5 bedrooms
Fluid depth In absorption field before test Din. Water added "m° gal. New depth 14.37 &*" in.
Elapsed Time: 1447 min. Final fluid depth 10.5 in. Absorption rate >= 750 g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN 8 type) N If yes, give date —
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
'Pump on' level at_ in. 'Pump off" level at w:15,0 alarm level at in.
Da Cycles tested Meets alarm & circuit requirements]
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot On adjacent lots
Absorption field on lot On adjacent I
Pubtic sewer main Public sewer manhotelcleanout
p Ic service line Holding tank
Animal containment areas 50+ft. Manure/animal excrete storage areas loo+ft.
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ ft. Property line5+ ft. Absorption field 5+ ft.
Water main 25+ ft. Water service line 10+ ft. Surface water 100+ ft.
Wells on adjacent lots 200+ ft.
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10+ ft. Building foundation 10+ ft. Water main 25+ ft.
Water Service line 10+ft. Surface water 100+ ft. Driveway, parking/vehicle storage 20 ft.
Curtain drain "onsh pxn10°•"' Wells on adjacent lots 200+ ft.
F. COMMENTS: On test dated 10/23108. the beginning water level was at 9•. After 917 gallons was introduced, the level was
11-1/4•. Jeff Poet at the MOA office was consulted during these tests.
G. ENGINEER'S CERTIFICATION �'� TM�.A� •�e'i
I certify that 1 have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date. s� '
c9y S T )�lM
Engineer's Printed Name Douglas T. Kenley ��� •' CE 9174 '
Date 162c zo!b
COSA Fee $ 4.30
Date of Payment to n�� ��g
Receipt Number 15
(Rev. 11105)
Waiver Fee $
Date of Payment
Receipt Number
�Uc�ur -doc..
Municipality of Anchorage
Development Services Department <
Building Safety Division
Onsite Water and Wastewater Program SA ITT
4700 South Bragaw St
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. 051801.23 HAA# 1SObi7
Expiration Date: � 12h= p
1. GENERAL INFORMATION
Complete legal description Lot 9 Block 5 Tablelands Subdivision
Location (site address or directions) 9.2$55 Whispering Birch Drive t
Current Property owner(s) Soinell Homes, Inc. Day phone 3445678
Mailing address 1900 Northern Uahts Blvd. Anchorage AK 99517
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
Five 5
TYPE OF WASTEWATER DISPOSAL:
❑
Individual On-site
❑
Individual Holding tank
❑
❑
Community On-sfte
❑
®
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an Independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with
valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water
system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's
work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verity that my Investigation,
based on procedures outlined in the Healty authority Approval Guidelines for this application, shows that the on-
site water supply and/or wastewater disposal system Is(are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my Investigation and inspection, the on-site water supply and/or
wastewater disposal system is(are) In compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of installation.
Name of Finn _Anderson Engineering Phone 522.7773
Address P.O. Box 240773 Anchorage. AK 99524
Engineer's Printed Name Michael E Anderson, RE Date 2123/2005
'.LY V
49th
5. DSD SIGNATURE Na co-r3ffi
_Ie�— Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report .
Other
By: At.
. . 0.0 � � Q Original Certificate Date:
(Rr. tm)
Municipality of Anchorage
• Development Services Department
Building Safety Division
On-site Water b Wastewater Program
4700 South Brag8W SL
P.O. Box 196850 Anchorage, AK 99519-6650
www.ci.anchorage.ek.us
(907) 343-7904
A. WELL DATA
Well hype _
Date completed
Total depth ft
Date of test
Static water level
Well production
HEALTH AUTHORITY APPROVAL CHECKLIST
If A, B, or C provide PWSID #
Sanitary seal (Y/N)—
Cased to ft
FROM WELL LOG
WATER SAMPLE RESULTS:
Coliform colonies/100 ml.
Date of sample.,
B. SEPTICIHOLDING TANK DATA
ft
9 -p.m -
Nitrate mg.A.
Collected by.
Tank Type/Materlal 60011COW
Tank size'1 MO gal• Number of Compartments I
Foundation deanout (Y/N) Y
Date of pumping
C. ABSORPTION FIELD DATA
Well Log (YIN)
Wires party p (YIN)
Casing height (above ground) in.
AT INSPECTION
ft
g.p.m.
Other bacteria
Date installed 9HTrM
Cleanouts (YM) Y
colonies/100 ml.
Depression over tank (YIN) )y High water alarm (YIN) N
Pumper Now Construction
Date installed 921rM Soil rating (g.p.d.M or felbdrm) A GPQW System type S Wide Shallow Trench
Length 199 ft. Width 3 ft Gravel below pipe 4 __ ft
Total depth 0 ft Eff. absorption area 1.680 ft? Monitoring tube y Depression over field N
Date of adequacy test Results (Pass/Fall) For — bedrooms
Fluid depth in absorption field before test _ in. Water added_ gal. New depth.— in.
Elapsed Time: _ min. Final fluid depth _ in. Absorption rate >- g.p.d.
b type) N If yes, give date
Any rejuvenation treatment (past 12 mo.) (YIN
i
II
D. LIFT STATION
Date installed Size in gallons
'Pump on' level at _ in. 'Pump off level at_ in.
It -Z I
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankf ft station on lot WA
Absorption field on lot WA
Public sewer main WA
Manhole/Ao ess (Y/N)
High water alarm level at in.
Meets alarm 6 circuit requirements?
On adjacent lots WA
On adjacent lots WA
Public sewer manhoie/deanout WA
Sewer /septic service line WA Nodding tank WA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >S Property line ?
Water main >1o' Water service line >10, Surface water MW
Wells on adjacent bis >2W
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >1W Building foundation >10' Water main MW
Water Service line >10' Surface water >IW Driveway, parlangNehida storage >S
Curtain drain None Noted Wells on adjacent lots >21V_
F. COMMENTS
G. ENGINEER'S CERTIFICATION
.T 1J:::
I certify that I have determined through field inspections and 49th
review of Municipal records that the above systems are in i
cwkwmance with MOA HAA guidelines in effect on this date.
;rmdaEL E. ANOM
Engineers Printed Name Michael E Anderson, PE, Bei„.. No. CE -an
Data 2M 05
HAA Fee $ 57 Waterer Fee $
Date of Payment f- ZJ - o S
Receipt Number `!g VS
(Rev. 12!00) FVI
Date of Payment
Receipt Number
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